NHS Chairs minutes: April 2024

Attendees and apologies

Health Board Chairs

• Lesley Bowie, NHS Ayrshire and Arran
• Karen Hamilto, NHS Borders 
• Nick Morris, NHS Dumfries and Galloway
• Patricia Kilpatrick, NHS Fife
• Neena Mahal, NHS Forth Valley (Interim Chair)
• Alison Evison, NHS Grampian
• Lesley Thomson, NHS Greater Glasgow and Clyde
• Sarah Compton-Bishop, NHS Highland
• Martin Hill, NHS Lanarkshire
• John Connaghan, NHS Lothian
• Meghan McEwen, NHS Orkney
• Gary Robinson, NHS Shetland 
• Lorna Birse-Stewart, NHS Tayside
• Gillian McCannon, NHS Western Isles
• Susan Douglas-Scott, NHS Golden Jubilee
• Carole Wilkinson, Healthcare Improvement Scotland
• David Garbutt, NHS Education for Scotland
• Keith Redpath, NHS National Services Scotland
• Alan Webb, NHS 24 (on behalf of Martin Cheyne)
• Angiolina Foster, Public Health Scotland
• Tom Steele, Scottish Ambulance Service
• Brian Moore, NHS State Hospital for Scotland

Scottish Government Officials

• Neil Gray, Cabinet Secretary for NHS Recovery, Health and Social Care
• Caroline Lamb, DG Health and Social Care/CE NHS Scotland
• John Burns, NHS Scotland Chief Operating Officer
• Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship
• Richard McCallum, Director of Health and Social Care Finance, Digital and Governance
• Jason Leitch, National Clinical Director
• John Harden, Deputy National Clinical Director
• Gillian Russell, Director of Health Workforce
• Fiona Hogg, Chief People Officer
• Donna Bell, Director of Social Care and NCS Development
• Angie Wood, Interim Director of Social Care Resilience and Improvement
• Richard Foggo, Co-Director of Population Health
• Gregor Smith, Chief Medical Officer
• Alex McMahon, Chief Nursing Officer
• Anne Armstrong, Deputy Chief Nursing Officer
• Alison Strath, Chief Pharmaceutical Officer
• Saira Kapasi, Head of Support for DG Health and Social Care and CE NHS Scotland
• Robert Kirkwood, Head of People and Governance Team
• Aislinn Ní Ghráinne, Strategic Briefing and Insights Unit Head

In attendance

• Donne Joyce,D eputy Private Secretary to Cabinet Secretary for NHS Recovery, Health and Social Care
• Rhea Crichton, NHS Executive Support to NHS Board Chairs and Chairs
• Karen Duffy, Delivery Director, Directorate for Social Care and National Care Service
• Katie Morris, Getting it Right for Everyone (GIRFE) Lead
• Rachel Dowle, Office of the Chief Designer – Head of Strategic Design
• Neil Robertson, Unit Head, General Practice Policy, and Strategy
• Josh McGinlay, Primary Care Strategy Senior Collaboration and Engagement Officer
• Malcolm Summers, Head of Strategic Reform
• Grant Laidlaw, Strategic Policy Manager

Secretariat

• Laurie Whyte, Board Governance and Appointments Team
• Kat Dobell, Board Governance and Appointments Team
• Sarah Hobkirk, Board Governance and Appointments Team
• Carol Hunter, Board Governance and Appointments Team

Apologies

• Martin Cheyne, NHS 24 (Alan Webb attending)
• Maree Todd, Minister for Social Care, Mental Wellbeing and Sport
• Stephen Gallagher, Director for Mental Health
• Tim McDonnell, Director Primary Care
• Andrew Watson, Director for Children and Families
• Douglas McLaren, Deputy Chief Operating Officer - Performance and Delivery

Items and actions

Minutes

Welcome, apologies for absence and attendees

Neil Gray, Cabinet Secretary for NHS Recovery, Health and Social Care welcomed everyone to the meeting. This was his second meeting with the NHS Chairs Group, and he thanked Chairs for their attendance.

Mr Gray welcomed Neena Mahal to her first meeting as Interim Chair of NHS Forth Valley.

Colleagues were reminded of microsoft teams meeting etiquette and invited to participate in discussions by raising their hands.

A full list of attendees and apologies is noted in annex A.

Minutes and actions from the previous meeting 

The minutes of the meeting held on 28 February 2024 were approved, pending an update received from the Scottish Ambulance Service.

Matters arising

There were no matters raised.

Cabinet Secretary remarks

The Cabinet Secretary gave introductory remarks which covered the following:

• primary care
• vaccinations
• finance

The Cabinet Secretary thanked Chairs for their continued support to the NHS at this critical time, noting that today’s agenda would follow on from the discussions from the last meeting, introducing preventative and pro-active care and an update on reform.

The Cabinet Secretary advised that after meeting with Cabinet on 16 April they collectively re-affirmed the need for fundamental reform for health and social care. He reassured Chairs that their views were important, and he understood that officials were developing an overarching roadmap for reform, setting out key areas to support delivery and will ensure continued engagement. Going forward, he was keen to consider future agenda items and reflect on how to help drive this forward locally.

The Cabinet Secretary reflected the importance of primary care as a critical part of the Scottish Government’s plans for longer-term reform of the NHS and its sustainability. He noted that Scottish Government officials were discussing this further with Chairs on 22 April.

The Cabinet Secretary advised that Public Health Scotland (PHS) has assumed responsibility for the Scottish vaccination and immunisation programme. He highlighted the part vaccinations play in terms of an immediate intervention to support our long-term health aims and asked Chairs to support the effective implementation of these vaccination programmes.

The Cabinet Secretary confirmed funding of £200 million for territorial boards to support cost pressures including agenda for change reform. £50 million of funding would go to territorial boards for stabilising planned care in 2024-25 and, as reducing long waits remained a top priority, a further investment of £30 million would come in addition to this to improve planned care in 2024-25.

The Cabinet Secretary understood the financial challenges being faced by boards and he remained committed to working with Chairs to agree priorities and ensure best value was achieved from the resources available. He concluded that in addition to reform and the changes that would need to take place, focus should still be on recovery.

Standing item – NHS recovery and performance (NHSC/24/25/01)

The Cabinet Secretary invited John Burns, Chief Operating Officer to lead the standing agenda item on NHS recovery and performance. A paper had been circulated to attendees in advance of the meeting and slides where shared during the meeting. This covered:

• planned care / waiting lists
• unscheduled care
• cancer waiting times

John Burns highlighted the challenges around waiting lists and encouraged colleagues to utilise capacity of the National Treatment Centres (NTCs), NHS Golden Jubilee and local systems. John advised he would be meeting Chief Executives to go through the emerging plan to strengthen other areas of opportunity and he would return to Chairs in due course to keep them informed of improvement and engagement with operational teams.

John Burns advised Chairs that the £50million revenue allocation was made available to protect planned care at 23/24 activity levels, whilst the additional £30 million would be used to support additionality. Key focus being to reduce long waits; diagnostics, cancer and orthopaedics.

Performance would be tracked against plans to show the impact on total numbers waiting. This will be illustrated in graphical presentations at future meetings.

Action: John Burns to update Chairs on developing improvement plans and engagement with operational teams and Chief Executives at a future meeting.

Chairs were invited to update on what work is being taken forward and what impact it would have, including sharing learning and good practice to scale up activity and improvement.

Gillian McCannon, NHS Western Isles and Meghan McEwen, NHS Orkney raised the ‘once for Scotland’ approach to planning and reform will need to take into account different challenges in the north based on the specific geography. Reflecting that the opportunities for reform in the north will inevitably be different and that leeway be given for those solutions and opportunities to emerge. Meghan added that bringing services to remote boards deliver a better outcome for patients and with the continued issues with transport this would be a welcome approach.

Alison Evison, NHS Grampian highlighted developing issues around long waits and how to deal with lower value/higher risk patients, with a national focus.

Martin Hill, NHS Lanarkshire noted that in Lanarkshire, most admissions were unscheduled. He gave an update on the work that his board is doing by developing flow navigation centres which utilise a range of alternative admissions, including 70 virtual beds, with plans to commission more.

It is hoped that a digital facility will be up and running by summer 2024, with e-triage and automatic self-check in, where patients could be prioritised within 5 minutes of arrival. More digital innovation could reduce costs, offer additional efficiency. It was acknowledged that teams would need to be intuitive of patients’ digital capabilities.

John Burns concluded that waiting times should be proportionate across all boards. Boards would be supported to maintain improvements and maximise capacity. The Scottish Government would work with teams, using NHS Golden Jubilee Hospital, NTCs and additional capacity within other boards. In response to comments regarding diagnostics, he advised that work was being taken forward through the recently established strategic diagnostic network.

Preventative and proactive care (NHSC/24/25/02)

The Cabinet Secretary invited Karen Duffy, Delivery Director for Preventative and Proactive Care to provide Chairs with an update on core workstreams within preventative and proactive care (PPC). Karen introduced colleagues, Grant Laidlaw, Strategic Policy Manager and Katie Morris, Getting it Right for Everyone (GIRFE) Lead, who provided a slide presentation introducing the preventative and proactive care programme of work and 4 the following core workstreams:

• getting it right for everyone (GIRFE)
• cardiovascular disease PPC programme
• waiting well
• PPC in primary care

The presentation provided a summary on how this work feeds into the reform agenda and how GIRFE is key to supporting personalised access to health and care putting people at the centre. Significant work has been done to co-design GIRFE with people both accessing and providing care which support us to deliver person centred care. Karen Duffy added that this was critical, not only for the health service, but for the whole system and for all public services and it should offer better prevention to support people’s health and wellbeing. Several health and social care partnerships are working together to co-design this work as pathfinders and partners and Chairs are encouraged to engage with this work and support those teams already involved and also to create the conditions locally for GIRFE to be implemented across health and social care services in Scotland.

Reform update (NHSC/24/25/03)

The Cabinet Secretary informed Chairs that he attended Cabinet on 16 April and presented a paper on reform. The focus will be on delivering real change, including tackling health inequalities, attracting, and retaining staff and reducing unwarranted variation.  Immediate and long-term reform changes were being taken forward but within a challenging fiscal position. He advised that a new primary and community care steering group has been set up to discuss longer term reform. John Burns added that a more detailed discussion with Chairs was required around the next critical steps to be taken forward and this would be revisited.

Feedback from NHS Chairs private meeting

The Cabinet Secretary invited Carole Wilkinson, Healthcare Improvement Scotland, and Chair of NHS Chairs Group, to provide feedback from the Chairs Private meeting and information ahead of a planned discussion on primary care on 22 April.

Carole Wilkinson noted 2 consistent themes running through discussions - the importance of communication and engagement with local communities and the necessity for Scottish Government and Health colleagues to work together. She noted that reform is encompassing the whole system and encouraged Chairs to focus on all public services when talking about reform.

Carole Wilkinson expressed her thanks on behalf of Chairs to Jason Leitch and Alex McMahon for their support and guidance over the years. The Cabinet Secretary additionally offered his thanks for their service over the years and for their commitment to the delivery of health and social care and wished them well for the future.

Any other business

There were no items of other business.

Date and time of next meeting

The next NHS Chairs meeting will take place on 22 May 2024. This will be a hybrid meeting hosted in the NHS Golden Jubilee board room.